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Merwyn Chew, Yingfeng Zheng, Jie J. Wang, Paul Mitchell, Ching Y. Cheng, Tien Y. Wong; Peripapillary Atrophy and Epiretinal Membrane - is there a relationship? The Singapore Malay Eye Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):996.
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Epiretinal membranes (ERM) have been associated with various retinal diseases, however the relationship between ERM and other retinal changes is uncertain. This study aims to describe whether peripapillary atrophy (PPA) is associated with ERM.
A population-based study of 3280 ethnic Malays, aged 40 to 80 was conducted in Singapore. Digital fundus photographs of both eyes were taken using a retinal camera and assessed by trained graders for the presence of ERM, PPA and other retinal diseases using standardized grading protocols. ERM was defined either as cellophane macular reflex (CMR), or a more severe form, preretinal macular fibrosis (PMF), and had to be within a 3000 mm radius grid on the macula. ERM was also differentiated into either primary or secondary (ERM in an eye with any retinopathy, retinal vein occlusion, late age-related macular degeneration or a history of cataract surgery). The association between PPA and ERM was examined using a multivariate logistic regression model with generalized estimating equation (GEE) to account for the correlation between eyes.
There were 3265 (99.5%) participants with gradable fundus photographs and 1521 (46.6%) of them had PPA. Of the 384 (11.8%) cases of ERM, 266 (8.1%) were primary ERM and 118 (3.6%) were secondary ERM. The number of participants with eyes having coexistent PPA and any ERM, CMR and PMF were 194 (12.8%), 94 (6.2%) and 100 (6.6%). Eyes with PPA were significantly more likely to have any ERM (OR 1.26; 95%CI 1.04, 1.54), PMF (OR 1.34; 95%CI 1.01, 1.77), primary ERM (OR 1.32; 95%CI 1.04, 1.66) and primary PMF (OR 1.58; 95%CI 1.11, 2.24), after adjusting for age, gender, alcohol consumption, education level, income, diabetes and myopia status. No association between PPA and secondary ERM was found.
PPA may be an independent risk marker for primary ERM, independent of myopia and other risk factors. This relationship should be further explored and confirmed in other studies.
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